Care Home: Rutland Villa

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What the care home does well People are given information in a way that helps them understand it.New people are supported to visit and try out the service before moving in.People can spend time doing things they like at home and they are helped to stay in touch with their families.The house is warm, homely and safe. People have private bedrooms with their own bathrooms.There are enough staff to give people one to one time. People are happy at the home and like the manager and staff.Proper checks are made on new people who come to work at the home. What has improved since the last inspection? Some people are involved in external activities that they enjoy and benefit from.People`s needs and wishes are now recorded more clearly in their care plans and these are reviewed each month.Each person now has a health action plan and is offered a full health check each year.More staff have an award in Care to help them do a better job.The home is well run and people are asked their views. What the care home could do better: People should have a care review meeting with their supporters at least two times a year.The meetings can help them plan their lives and goals.People could be helped to start looking after their own money.Some people could be helped to try more meaningful activities.One person`s bedroom needs to be made nicer and broken things replaced.The staff could be better trained to help them meet people`s special needs.Health specialists should be asked to help some people with their difficulties. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rutland Villa 62 Chesshire Avenue Stourport on Severn Worcestershire DY13 0EA The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jean Littler Date: 0 8 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 39 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Rutland Villa 62 Chesshire Avenue Stourport on Severn Worcestershire DY13 0EA 01299879221 01299879576 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Minster Pathways Limited care home 3 Number of places (if applicable): Under 65 Over 65 3 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 3 The maximum number of service users who can be accommodated is: 3 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 39 A bit about the care home The house is in a quiet road about 2 miles from Stourport-on-Severn. The home is for 3 adults who have a learning disability. It is near a bus route and local shops, cafes and pubs. Care Homes for Adults (18-65 years) Page 5 of 39 There is also a car to take people out. Care Homes for Adults (18-65 years) Page 6 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 7 of 39 How we did our inspection: This is what the inspector did when they were at the care home We carried out this inspection over one day. We spoke with the manager and two staff. We looked around the house. The people who live at the home showed us their bedrooms. The residents, three of their families, some staff, and one health worker returned surveys to give us their views. These showed that people are happy living at the home. Care Homes for Adults (18-65 years) Page 8 of 39 We looked at records such as care plans, medication and staff rotas. What the care home does well People are given information in a way that helps them understand it. Care Homes for Adults (18-65 years) Page 9 of 39 New people are supported to visit and try out the service before moving in. People can spend time doing things they like at home and they are helped to stay in touch with their families. The house is warm, homely and safe. People have private bedrooms with their own bathrooms. Care Homes for Adults (18-65 years) Page 10 of 39 There are enough staff to give people one to one time. People are happy at the home and like the manager and staff. Proper checks are made on new people who come to work at the home. What has got better from the last inspection Some people are involved in external activities that they enjoy and benefit from. Care Homes for Adults (18-65 years) Page 11 of 39 Peoples needs and wishes are now recorded more clearly in their care plans and these are reviewed each month. Each person now has a health action plan and is offered a full health check each year. More staff have an award in Care to help them do a better job. Care Homes for Adults (18-65 years) Page 12 of 39 The home is well run and people are asked their views. What the care home could do better People should have a care review meeting with their supporters at least two times a year. Care Homes for Adults (18-65 years) Page 13 of 39 The meetings can help them plan their lives and goals. People could be helped to start looking after their own money. Some people could be helped to try more meaningful activities. One persons bedroom needs to be made nicer and broken things replaced. Care Homes for Adults (18-65 years) Page 14 of 39 The staff could be better trained to help them meet peoples special needs. Health specialists should be asked to help some people with their difficulties. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Jean Littler Care Homes for Adults (18-65 years) Page 15 of 39 Regulatory Inspector CQC 77 Paradise Circus Queensway Birmingham B1 2DT If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 16 of 39 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 17 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Potential new residents are given information about the service but this can be improved. They will have their needs assessed and be given the opportunity to trial the service. Evidence: A Statement of Purpose and a Service Users Guide are available to interested parties. The Guide has been developed into an accessible format with symbols and simple clear text. The fees are not included in the Guide as required under regulation 5. Mrs Telford agreed to amend the Guide to show the fess and details of what is and is not included in the fees, such as holidays and services such as chiropody. No new people have been admitted to the home since January 2007 when two people moved in within a few months of each other. Staff told us that the group are quite compatible and now know each other well. One person returning from an outing hugged one of her peers in greeting. A relative of one of these people told us. My son is very happy at the home. I am more content with this placement than any other in the last 24 years. Care Homes for Adults (18-65 years) Page 18 of 39 Evidence: The assessment process for one of these people was looked at during the last inspection. The findings showed that that a comprehensive policy is in place that outlines how the admission of new residents will be achieved. Evidence showed this had been followed with assessments being completed by staff from the home and by the social worker from the placing authority. Introductory visits had been arranged to help inform all those involved about the suitability of the placement. The AQAA contained detailed information about how any potential new admission would be managed and this showed that Mrs Telford has a good understanding of best practice in this area. Care Homes for Adults (18-65 years) Page 19 of 39 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Peoples needs are recorded in their care plans and kept under review. More frequent formal review meetings would support the person centred planning process. People are supported to make plans for their future and have goals to work towards. They are enabled to take risks in order to have a normal lifestyle and are supported to make choices. Evidence: Care planning procedures seem well developed. Two peoples records were sampled and these contained very detailed person centred information. For example, one man had twenty care plans for different support areas. The plans have been written in a respectful and sensitive way that highlighted peoples preferences. They explained the support needs well and gave clear guidance that includes how to ensure peoples privacy and dignity are maintained and their independence promoted. Files included risk assessments areas such as for personal finance management, community outings, vehicle safety and access to the kitchen. The plans included details of the areas staff are supporting people to develop life skills in. Goals also include one off development such as being able to manage going on a short break. Staff confirmed that they are Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: made aware if peoples needs change and that the care plans were very helpful when they started in post. All information had been reviewed in April 2009 and signed by staff. More information is needed about two areas, the arrangements for monitoring epilepsy and weight control. Mrs Telford agreed to add this. Families confirmed in surveys that they felt the service was meeting the needs of their relatives. One commented that she is always kept informed and consulted appropriately. There is not a version of the plan that is in an accessible format and life books are not in use. Mrs Telford should access the person centred planning, PCP, training offered by Worcestershire council and consider which of the PCP methods would be best suited to the residents. Monitoring is proactive as keyworkers summarise the daily notes, charts and incident or accident reports each month and then a keyworker meeting is held with Mrs Telford where progress or concerns are discussed. Both mens annual reviews with their placing authority were over due. Mrs Telford was advised to hold six monthly reviews and to invite all representatives, as described in the National Minimum Standards. Personal care information in regular use is stored on open shelves in the dining room. Although staff would not let unauthorised people read the files a more secure arrangement would help ensure confidentiality. People have some complex behaviours that can challenge staff and cause difficulties for them that limit their quality of life. Although the home was set up for people with these needs the owners do not provide any specialist services such as behaviour therapy. Currently no psychology support is being provided by the local authority. Mrs Telford said the Behaviour Team were involved when people first moved in but when they settled this was withdrawn. Consideration should be given to requesting support again to help with specific areas that affect the quality of life of two people. It is positive that staff are provided with training regarding behaviours and that Mrs Telford has produced a behaviour response plan for one person and is working on one for the other. Medication has been prescribed to be given when people show certain symptoms and behaviours, however, this is not needed very often. Appropriate records are kept about behaviours and incidents and only low level physical interventions are now being used. There are care plans about how each person is supported with making decisions. These could be expanded to make reference to the arrangements under the Mental Capacity Act. The care plans encourage staff to enable people to make decisions for themselves and staff were observed to offer choices and respect peoples decisions during the day. As some people have Autism Spectrum Disorder they are not always able to cope with choice and decisions as these will cause great anxiety. Staff are provided with training in ASD. There are helpful communication profiles in the care plans. More reference to ASD may help remind staff about the condition and how to work positively with it. Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: Care Homes for Adults (18-65 years) Page 22 of 39 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported to develop practical skills and make decisions within their capacity. They choose how to spend their time at home and have the opportunity to take part in outings. The quality of life of some residents could be improved if they were enabled to take part in more external and community based activities. People stay in touch with family and friends and they enjoy their meals. Evidence: There was a relaxed and homely atmosphere that must help people stay calm and feel happy. People seemed confident about choosing where they spent their time and what pastimes to engage in. For example in the afternoon one resident choose to watch television in her room where she was heard laughing, which staff said is very common. One man chose to do colouring and another played basketball with staff and then listened to music in his bedroom. People are being supported to carry out normal household activities such as cleaning their bedrooms and doing their laundry. Care Homes for Adults (18-65 years) Page 23 of 39 Evidence: Mrs Telford reported that an outing is usually arranged each morning that can include going to the shops, going to the park or having a picnic lunch. Birthdays and other festivals are celebrated and peoples relatives are invited to these. Visitors are made welcome and some people go to visit family members. A weekly plan for proposed activities is produced and a record is made of whether people enjoyed what they took part in. One person has some structured activities such as attending two college courses and doing volunteer work with an elderly man who needs help around his home and his dog walked. Good progress has been made to widen this persons social and educational opportunities since the last inspection. The two other residents do not have any structured activities. Both can refuse outings if they become anxious about them so they are therefore not given advance notice. Daily records showed one person usually only goes out for a drive. Mrs Telford said they try to involve him as much as possible, for example, he wanted to buy flowers for a family member so came for the drive to the shop and chose a bunch outside but did not go in as he may not have coped with this. He did enjoy a trip to the coast with the other two residents, which is going to be tried again. Mrs Telford reported that she plans to try to develop activities further over the next year. Two people are due to go on a short break this year. Feedback from relatives in surveys included, The care and support is very good and my granddaughter is happy and out and about everyday; The social care is good, I have no problems at all; They cater for my sons needs in every respect. They keep in touch by helping him with letters and they take him shopping. He is very happy there; They could do more activities outside of the home and more educational activities indoors. Staff feedback was also positive, however, one worker felt more activities could be provided. Food is purchased locally and staff prepare the meals. The menu showed that two choices are offered for all meals. If neither are wanted staff told us a different meal is provided. Staff eat with the residents and mealtimes seemed to be relaxed and enjoyable. Care Homes for Adults (18-65 years) Page 24 of 39 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are being supported with their personal and healthcare needs and are being encouraged to be independent where possible. Peoples medicines are being safely managed on their behalf but staff training needs to be expanded. Evidence: People all looked very well presented. Some people are accessing community facilities such as hairdressers. The personal care needs of each person are well documented and the guidance promotes their privacy, dignity and independence. A chart showed that people are being supported to have regular baths, shaves, teeth cleaned etc. Staff interactions observed were friendly but respectful. The ensuite facilities help provide privacy and Mrs Telford said there is always a female carer on to support the one female resident. People are all registered with local doctors and dentists. Records are made in their care plans related to the outcomes of health appointments. Health Action Plans have been completed and annual health prevention checks are being provided by the doctor. A record is being made is people refuse these. Staff have helped one person have his blood pressure taken by seeing his peers having the Care Homes for Adults (18-65 years) Page 25 of 39 Evidence: check. Care plan information should be expanded about two health areas that Mrs Telford was made aware of. Additional specialist health support and advice has been sought in the past. For example the Continence Advisor was involved with one person and this has had very positive outcomes. Peoples weights are being monitored, however support from a dietician may well be helpful for one persons long term health. Medication arrangements were well organised and policies and procedures are in place. Information about medication is provided for residents in picture format, to aid their understanding. A Monitored Dosage System is in use, and the supplying pharmacist has provided training for staff on the system. The Medication Administration Records were seen and had been completed to a good standard. Senior staff usually give medication. Some of these still need to attend an accredited medication management course. Peoples medication regimes are being kept under review. Mrs Telford plans to discuss one persons medication again at his next appointment to see if a reduction can be tried. She agreed to carry out a risk assessment about the mans epilepsy if a reduction is agreed. Protocols are in place for medication that is only given under certain circumstances. The doctor has signed agreement for certain non prescription medications to be used for minor ailments such as headaches and colds. Care Homes for Adults (18-65 years) Page 26 of 39 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People and their representatives are supported to express their views and these are listened to and acted upon. People are being protected from potential abuse or neglect but arrangements would be strengthened if all staff attend formal safeguarding training and periodic refreshers. The owners and manager were not informed about legal changes in the way that vulnerable adults are protected. Evidence: Mrs Telford reported in the AQAA that the complaints procedure is given to relatives when someone moves into the home and that an accessible version is given to the resident. No complaints have been received by the home or by us in the last two years. Feedback in surveys and from speaking to staff showed that the manager is approachable and that people feel they can raise their views or concerns. Relatives felt any concerns would be taken seriously and acted upon. The residents would find it difficult to follow a formal complaint route but close keyworking arrangements and family links help ensure their happiness and wellbeing is being monitored. The staff spoken with were aware of their duty of care to report any abuse or concerns to help protect people in the home. Abuse and whistle blowing policies are in place and staff are made aware of these during their induction. Not all staff have attended formal safeguarding training but Mrs Telford has arranged for some to attend a course in July. Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: Mrs Telford is due to attend training for managers on Safeguarding Vulnerable Adults. She told us she has recently clarified protection procedures with her line manager. Appropriate recruitment checks are helping to protect people. Mrs Telford was not aware about the introduction of the Independent Safeguarding Authority which recently replaced the POVA system. This has implication for staff recruitment and for how serious concerns about the suitability of care staff are now managed so she needs to inform herself. The owners should have been aware of these changes and made sure Mrs Telford knew about them. Care Homes for Adults (18-65 years) Page 28 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a well maintained, comfortable, safe and clean home. There is scope for some further improvements. Evidence: Rutland Villa is a large, three bedroomed, detached house, situated in a pleasant residential area, approximately 2 miles from the town centre of Stourport-on-Severn. There is access to public transport, although some residents cannot use this. A people carrier is provided. The premises are reasonably well maintained. Mrs Telford reported in the AQAA that two bedrooms and the lounge have been redecorated in colours chosen by the residents. One resident has a new bedroom carpet and all maintenance tasks are up to date. The owners provide a part time handy person to carry out general work. There is a small enclosed level garden that provides a suitable area for residents to use. This was quite well kept but the drive area outside the garden was full of weeds and did not look welcoming. The solid gate is locked and there is no intercom or notice. Visitors have to wait for staff to come across the garden without knowing if anyone is home. There is also no indication of the name or number of the home at the entrance. Care Homes for Adults (18-65 years) Page 29 of 39 Evidence: There is a bright modern open plan kitchen diner that seems to be the heart of the home. It is positive that no food is locked away and people are encouraged to help prepare drinks and snacks. The lounge is very small particularly as the service is for people with challenging behaviours. It would not seat the three residents and the staff on duty. It is fortunate that one person who has a large ground floor bedroom chooses to use his room as his main living area. He also has his own armchair in the dining room. Mrs Telford told us that it is only recently that pictures have stayed on the lounge wall as one resident would previously insist these were removed. The stairs face the front door and there is a step up into the communal rooms on either side. The inspector and a visitor tripped as they arrived. Upstairs there is an office and two other bedrooms, one of which is also very large. All bedrooms have en suite toilet, shower or bath facilities which provides privacy. There is a separate staff toilet. The ground floor bedroom has access to the garden through French windows. Two peoples bedrooms reflect their tastes and interests and were very attractive. One resident finds it very difficult to have personal positions in his room and when he becomes upset he will damage the room and things in it. This can be quite common with this client group, however, rooms can still be made more homely and appropriately fitted out than this one is. The home was clean and fresh. Mrs Telford told us in the AQAA that servicing contracts are in place, and that records are maintained to show that equipment and the fire alarm system are routinely checked. There are systems in place to manage the control of infection such as cleaning schedules. Staff are awaiting infection control training. The laundry is set up in an outbuilding. Staff support residents to be involved in doing their laundry but the location means the weather can affect this. It is very positive that the Environmental Health Department inspected the kitchen in 2007 and rated the arrangements as four star. Protectively clothing is available to staff and they attend health and safety training. Care Homes for Adults (18-65 years) Page 30 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People like their staff are there are enough on duty to meet their needs. The staff are positive and they respect the people in the home. Staff training arrangements can be further improved to help staff provide a specialist service. People are being protected by the recruitment procedures. Evidence: Staffing arrangements at the home have been quite stable since the last inspection with two workers leaving. However, recently two new staff left without giving their notice after deciding they were not suited to the role and two others left for personal reasons. Replacement staff have been recruited and the residents are getting to know them. A full time waking night worker is on maternity leave so cover is being provided for this post by staff working overtime. There are two male staff, which is positive for the male residents. The residents said they liked the staff and their interactions with staff backs this up. Survey feedback was also positive about staffing levels, skills and attitude. Observations saw staff engaging with residents in a gentle and calm manner, while helping them make choices or take part in activities. Some interactions could be more adult. At times people were told they were a good girl or boy or had their hair stroked in a parental way. Three staff are usually on both day shifts and at night there is one waking worker and a senior on call. If due to sickness only two are on duty then Mrs Telford said she Care Homes for Adults (18-65 years) Page 31 of 39 Evidence: stayed on until after the evening meal or one of the residents goes to spend time at the deputys house nearby, which she enjoys. On the day the waking night worker had come into cover an afternoon shift. This means she was going to work from 2pm until the following morning. Overnight she would be on duty alone. This is not good practice and long working hours should be avoided as they can mean staff are unable to respond appropriately to difficult situations. Discussions with the staff on duty during the visit, about their experiences of working at the home, the induction process, and the training opportunities provided, confirmed that appropriate procedures had been followed. They had felt welcome, had shadowed colleagues for several shifts and felt well supported. Two new workers recruitment records showed that appropriate selection procedures had been followed and relevant checks had been carried out such as three references and a Criminal Record Bureau CRB check. One worker had started before the CRB had been returned, however the references and a POVA First check had been received. Mrs Telford confirmed that the worker was supervised at all times until the CRB was received. One workers induction record showed this had been completed. The induction design is being improved to come in line with guidance from Skills for Care and the Common Induction Standards. Mrs Telford had a copy and intends to use this with any new staff and will also encourage others to work through it. Mrs Telford has a training matrix and is aware that there are gaps in staffs training profiles. For example, some staff need to attend an accredited medication management course, training on infection control and first aid. Staff have all been provided with accredited training to help them respond to challenging behaviour and to use physical intervention if needed. Several staff were on a health and safety course on the day. It is positive that Autism awareness training is provided. Currently staff are not offered training on total communication. This should be arranged to help new workers understanding this important area and to back up current good practices in the home. Sign-Along training should also be provided as residents use signs to help them communicate. Person centred planning should also be accessed. National Vocational Qualification NVQ awards are being well promoted. The deputy and both seniors hold the level 2 award and two of these are working towards gaining the level 3. Three staff have no qualifications but two are due to start an NVQ award soon and the other one is due to enrol. At the last inspection the previous manager reported that the Learning Disability Award Framework was due to be introduced. This did not happen. Mrs Telford said all staff are registered for the new Learning Disability Qualification and will starts this soon. Mrs Telford holds monthly staff meetings, annual appraisals are carried out with each worker and bi monthly personal supervision and support sessions to help them with their role. All information indicated that the team is functioning professionally and morale is good. Care Homes for Adults (18-65 years) Page 32 of 39 Evidence: Care Homes for Adults (18-65 years) Page 33 of 39 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are benefiting from a well run home that has a positive ethos. The owners should try and ensure that the management arrangements remain stable to benefit the residents. Evidence: There have been four managers since the home was opened at the end of 2005. The current manager, Mrs Telford was the deputy and took over when Ms Sharman moved elsewhere in the organisation. Mrs Telford has several years relevant experience and holds an NVQ 4 award in Health and Social Care. She is due to start the NVQ Managers Qualification at Wolverhampton College. She was registered by the Commission in July 2008. Mrs Telford has attended some relevant training such as the mental capacity act and is aware of other courses she needs to access to ensure her knowledge is up to date. She feels supported by the owners and has suitable budgets to run the service. She needs to ensure she stays up to date with legal developments that impact on the service and the owners need to be more proactive in this area. The AQAA was completed well and showed that Mrs Telford has a clear understanding of the service provided and areas Care Homes for Adults (18-65 years) Page 34 of 39 Evidence: that can be further improved. Future AQAAs would be improved if they contained more examples of direct outcomes for people using the service and more specific details about planned areas for improvement. To consider how the service can move towards gaining a rating of excellent, Mrs Telford should consult the Quality Rating guidence on the Commissions web site called KLORA. Feedback in our surveys was very positive about the way the home is managed. Staff were positive about Mrs Telford and reported she was supportive and approachable. She was helpful during the inspection and open to feedback. There is a quality monitoring system in place. This includes audits and annual surveys. The findings from each years reviews are not currently reported back to stakeholders in an annual report. Mrs Telford said the AQAA had been made available to families but a shorter report and action plan might be of more interest to staff and relatives. The surveys were not available as they were with the area manager. The owners have been carrying out regular visits to the service as required under Regulation 26. Mrs Telford has not submitted any notifications to the Commissions of events in the home. A discussion was held to clarify what must be reported, for example incidents that result in physical intervention or injuries. Health and safety matters are being appropriately managed through risk assessments and routine checks. Fire evacuations are held each month to help people learn to leave the building. There are gaps in some staffs safety training, such as first aid, that are being addressed. Mrs Telford seemed to have effective record keeping systems in place. The balance in each residents cash tins are checked at every handover. A sample of receipts showed that people are being supported to buy appropriate items with their personal money. Currently peoples money is kept in the office. Consideration should be given to helping some people to keep their cash tins in their bedrooms, even if they cannot manage the key to start with. This would be more person centred. Care Homes for Adults (18-65 years) Page 35 of 39 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 36 of 39 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 6 Include the fee range and details of what is and is not included in the fees in the Service Users Guide. Seek advice from the behavioural team about how one person can be supported to have personal possessions and how another person can be motivated and enabled to participate more in the community. Consider requesting a diagnosis for one person who may be on the Autism Spectrum. Develop care plans further to more include information about how ASD affects people and the specific support they need because of the condition. Hold review and person centred planning meetings at least every six months with each resident and their representatives. Provide more secure storage for peoples personal information. 3 6 4 6 5 10 Care Homes for Adults (18-65 years) Page 37 of 39 6 12 Further opportunities should be identified for some residents to participate in various activities in the community, to ensure that their lives are as interesting and meaningful as possible. Request support from a dietician. The manager needs to become familiar with her responsibilities in relation to the new Independent Safeguarding Authority. The owners need to review how they are keeping informed about changes in the care sector so they are operating their services in line with current legislation. Avoid staff working long working hours. Address the training gaps identified. The owners should support the manager to ensure she is able to complete the Managers Qualification within a year. 7 8 19 23 9 23 10 11 12 33 35 37 13 39 Continue to develop the annual quality assurance process and consider how interested parties can be provided with feedback so they know their feedback has been considered and contributed in the development plan. Consider supporting people to keep their money in their own rooms. 14 41 Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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